Did Your Physician Get Your Antibiotic Therapy Right the First Time?

9/18/15: Community acquired or hospital acquired bacterial infections are among the most deadly conditions patients face each year. Because of the high morbidity and mortality associated with bacteremia, prompt evaluation and appropriate antibiotic treatment are of paramount importance when a physician suspects that a patient has acquired a bacterial infection. As many of you are likely aware, when a bacterial infection is suspected, the first step in treating the infection is to fully identify the type of bacteria that is present. This is accomplished by drawing a sample of the patient's blood (called cultures) and testing it in a laboratory. Laboratory technicians often employ a method of testing known as "gram staining". This method involves utilizing a chemical stain known as "crystal violate" to a slide containing the blood specimen. The slide is then rinsed with water and placed in iodine and then either acetone or alcohol (this is called decolorization). This process, in general, permits the laboratory technicians to categorize the observed micro-organisms in a patient's blood (under the microscope) into two major groups, gram positive bacteria or gram negative bacteria. Gram positive bacteria retains the crystal violent stain and appears purple under the microscope while gram-negative bacteria does not retain the crystal violet and appears pink in color. Although there are, admittedly, some bacterial species that cannot be visualized by the gram stain technique, the major groups of bacteria generally fall into one of these two categories. In addition to "positive" or "negative", gram-stained bacteria are also described according to how the bacteria are shaped; i.e., cocci (spherical), bacilli (rod-shaped), how they are arranged; i.e., in chains or in clusters, and their size.

So, why is all of this information important to health care providers? Because each type of bacteria has a typical microscopic "signature." For example, gram-positive cocci (sphere-shaped) in clusters usually indicates the presence of Staphylococcus species of bacteria, whereas gram-positive cocci in chains usually indicates the presence of Streptococcus or Enterococcus species of bacteria.

Why is the species of bacteria important to clinicians? It's simple. Each species of bacteria is either resistant or sensitive to particular antibiotics. Once clinicians know the species of bacteria that is infecting one of their patients, and what it's susceptibilities are, they are able to prescribe an antibiotic that they know will likely destroy the bacteria.

Now, unfortunately, the process of determining the species and susceptibility of a particular bacteria does not occur in mere minutes or hours, but rather can take up to 48 hours. In fact, typically all that a clinician knows in the short term is that the bacteria is gram positive/negative and how they are arranged (chains/clusters). Based on this information, however, in order to effectively safeguard a patient until such time as the specific bacterial species and susceptibility are known, the clinician must prescribe a broad enough empirical dose of antibiotics to protect the patient from harm. Typically, this involves the prescription (in gram-positive infections) of powerful antibiotics such as vancomycin or gentamycin, antibiotics that can be scaled back to more focused antibiotics days later when more information about the specific bacteria is known. Failure to do so, can expose a patient to worsening sepsis, organ failure or even death.

If you or a loved one believe your physician failed to properly prescribe the proper course of antibiotics and this failure resulted in catastrophic injury or death, call our lawyers at 410-385-2225 for a free consultation.

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